WHO Risk Assessment

Risk Assessment

Local Risk

High

Ituri Province, DRC

Regional Risk

High

East Africa

Global Risk

Low

International

Clinical Summary

Outbreak Overview

WHO confirmed a Bundibugyo strain Ebola virus disease outbreak in eastern Democratic Republic of Congo, centred in Ituri Province. Cases have been reported in Mongbwalu, Rwampara, and Bunia, with imported cases reported in Uganda.

No approved vaccine or specific treatment currently exists for Bundibugyo Ebola virus disease. Management is primarily supportive. Existing Ebola vaccines (rVSV-ZEBOV) were developed against the Zaire ebolavirus and are not validated for the Bundibugyo strain.

Pathogen: Bundibugyo ebolavirus (BDBV), a member of the Filoviridae family
Healthcare worker deaths have been reported in the affected areas
Cross-border transmission confirmed with imported cases in Uganda
WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC)
WHO and partners deployed rapid response teams, laboratory support, PPE, surveillance systems, and isolation units
Contact tracing and community engagement operations are ongoing

Outbreak Map

Outbreak Spread Map

This map shows where Ebola cases have been reported across Ituri Province, DRC, and cross-border transmission into Uganda.

Map data for illustrative and educational purposes. Outbreak zone boundaries and intensities are approximate. Refer to WHO situation reports for authoritative geographic data.

Timeline

Outbreak Timeline

Early 2026

Initial cases identified in Ituri Province, DRC. Cluster of unexplained haemorrhagic fever cases reported in Mongbwalu health zone.

Weeks following

Laboratory confirmation identifies Bundibugyo ebolavirus (BDBV). DRC Ministry of Health declares the outbreak.

Spread to Bunia

Cases reported in Bunia, the provincial capital of Ituri. Healthcare worker infections reported. Rwampara also affected.

Cross-border transmission

Imported cases reported in Uganda. Cross-border surveillance enhanced between DRC and Uganda. Ugandan Ministry of Health activates Ebola preparedness plan.

15 May 2026

Africa CDC confirms outbreak. DRC's INRB laboratory detects 13 samples positive for Ebola virus. Sequencing identifies the Bundibugyo strain in Ituri Province. Uganda declares an outbreak following a confirmed case in Kampala with travel history to Ituri.

17 May 2026

WHO declares PHEIC. The Emergency Committee determines the outbreak constitutes a Public Health Emergency of International Concern due to cross-border spread, healthcare worker infections, and the lack of a validated vaccine for the Bundibugyo strain.

18 May 2026

UKHSA issues Briefing Note 2026/014. IRP Level: Enhanced. Clinicians advised to consider EBOD in unwell patients with travel to DRC, Uganda, or link to suspected case within 21 days. ACDP VHF guidance and IFS referral pathway emphasised. Returning Workers Scheme activated.

Ongoing

Response operations continue. WHO and partners deploying rapid response teams, laboratory support, PPE, isolation units, and community engagement across affected areas.

Infection Prevention

Infection Prevention and Control

Personal Protective Equipment (PPE)

Full PPE required for all contact with suspected or confirmed Ebola patients
Fluid-resistant coverall or gown, double gloving, FFP3/N95 respirator, face shield or goggles, waterproof apron, and rubber boots
Trained donning and doffing procedures with a designated buddy observer
PPE supplies must be maintained and stockpiled in advance of need

Isolation and Patient Management

Immediate isolation of suspected cases in a dedicated treatment unit or single room
Negative-pressure rooms where available; otherwise closed-door single rooms
Strict visitor restrictions and access control
Dedicated patient care equipment (non-shared)
Safe waste management. Treat all waste as Category A infectious waste

Contact Tracing

Rapid identification and follow-up of all contacts of confirmed and probable cases
21-day monitoring period from last exposure (Ebola incubation period: 2-21 days)
Daily temperature checks and symptom monitoring for all contacts
Community engagement teams to support tracing in affected areas

Safe and Dignified Burial

Deceased Ebola patients are highly infectious. Safe burial procedures are critical
Trained burial teams in full PPE must handle all remains
Body bags and disinfection protocols must be followed
Community and religious leaders engaged to ensure culturally sensitive but safe practices

Cross-Border Surveillance

Enhanced surveillance at DRC-Uganda border points of entry
Temperature screening and health declaration forms at border crossings
Joint DRC-Uganda surveillance coordination and data sharing
Alert systems for neighbouring countries (South Sudan, Rwanda, Burundi)
WHO International Health Regulations (2005) notifications issued

Emergency Medicine

Emergency Medicine Relevance

Key awareness for ED clinicians: Global risk is low, but you should know how to recognise viral haemorrhagic fever and how to escalate. Any returned traveller from DRC or Uganda with fever and compatible symptoms should prompt immediate consideration of Ebola.

Recognition of Viral Haemorrhagic Fever

Acute febrile illness with haemorrhagic manifestations in a returned traveller from an endemic area
Unexplained fever, myalgia, headache, vomiting, and diarrhoea with epidemiological link
Rapidly progressive illness with bleeding, organ dysfunction, and shock
Incubation period: 2-21 days. Travel history within this window is critical

ED Isolation Precautions

Immediate isolation in a negative-pressure room or closed single room
Full HCID-level PPE: FFP3 mask, fluid-resistant gown, double gloves, face shield, waterproof apron
Limit the number of staff entering the room to the absolute minimum
Do not perform aerosol-generating procedures without full HCID precautions

Early Escalation

Notify immediately: Microbiology/Infectious Diseases consultant, Infection Prevention team
Contact the UKHSA Imported Fever Service (0844 778 8990), available 24/7
Discuss with local Health Protection Team for public health notification

HCID Referral Awareness

Ebola is classified as a contact/blood-borne HCID in the UK
Suspected cases should be discussed with the HCID network
Specialist units: Royal Free Hospital (London) and Newcastle upon Tyne Hospitals
Transfer arrangements coordinated via HCID protocols

Public Health Notification

Mandatory notification to UKHSA for suspected viral haemorrhagic fever
IHR (2005) reporting obligations via national focal point
Coordination with local HPT for contact tracing of any identified contacts

UKHSA Alert — 18 May 2026

UKHSA Briefing Note 2026/014: Ebola Disease, Bundibugyo Virus, DRC and Uganda

Serial number 2026/014 · Issued 18 May 2026 · IRP Level: Enhanced

Clinicians should consider Ebola disease (EBOD) in unwell patients with a history of travel to the DRC, Uganda, or another country where there is a risk of EBOD, or a link to a suspected case, within 21 days before onset of illness. Follow the ACDP VHF algorithm for risk assessment and discuss suspected cases with local infection specialists and the Imported Fever Service.

Summary

On 17 May 2026, WHO declared a Public Health Emergency of International Concern for a new outbreak of Ebola virus disease (EBOD) caused by Bundibugyo virus in the DRC and Uganda
Clinicians should follow the ACDP guidance for risk assessment and management of viral haemorrhagic fevers to safely assess and test suspected patients
NHS infection services should discuss suspected cases with the Imported Fever Service (IFS) to arrange urgent testing. Confirmed cases will be managed via the HCID network
Suspected cases should also be notified to local health protection teams
UKHSA is monitoring and assessing the risk to public health in the UK. The Returning Workers Scheme (RWS) has been activated for organisations deploying workers to affected areas

Background

Orthoebolaviruses are filoviruses which can cause a severe and often fatal haemorrhagic fever called Ebola virus disease (EBOD). In the UK, EBOD is classified as a high consequence infectious disease (HCID)
On 15 May 2026, Africa CDC reported a confirmed EBOD outbreak in Ituri Province, DRC. DRC's INRB laboratory detected 13 samples positive for Ebola virus, with sequencing identifying the Bundibugyo strain
On 15 May 2026, Uganda declared an EBOD outbreak following laboratory confirmation in an individual with recent travel to Ituri Province who sought care at a hospital in Kampala on 11 May 2026
There are significant uncertainties around true case numbers and geographic spread. A high positivity rate, cases in Kampala, and increasing clusters of deaths across Ituri Province potentially indicate a larger outbreak than currently detected
Case fatality rate in previous EBOD outbreaks: 25% to 90%. There are currently no licensed therapeutics or vaccines for EBOD caused by Bundibugyo virus (BDBV)
Incubation period: typically 2 to 21 days (average 8 to 10 days). Initial symptoms include severe headache, malaise, high fever, and myalgia, progressing to nausea, vomiting, diarrhoea, and haemorrhagic fever
Transmission: direct contact with blood, secretions, organs, or bodily fluids of infected people; contaminated surfaces and materials; sexual transmission possible (virus found in semen for weeks post-recovery); needlestick injuries carry higher risk
This is the 17th EBOD outbreak in the DRC

Recommendations for Emergency Clinicians

Clinicians should be alert to the possibility of EBOD in unwell patients where there is a history of travel to the DRC, Uganda, or other countries where there is a risk of EBOD, or a link to a suspected case, within 21 days before onset of illness. Use the ACDP VHF algorithm to facilitate risk assessment and discuss with local infection specialists. Remember to test for malaria but consider the possibility of dual infection.

Infection specialists should discuss all suspected EBOD cases with the UKHSA Imported Fever Service (IFS) on 0844 778 8990 (available 24/7). IFS will advise on testing, immediate clinical management, and differential diagnosis
Samples should be sent to the Rare and Imported Pathogens Laboratory (RIPL) as directed by IFS
Confirmed EBOD cases will be managed through the specialist HCID network
Suspected cases should be notified to the local health protection team

Key Contacts

Imported Fever Service (IFS): 0844 778 8990, available 24/7 for clinical advice on suspected Ebola cases, testing, and management
RIPL: 01980 612348, 9am to 5pm weekdays for laboratory testing queries
EIZ Team: EpiIntel@ukhsa.gov.uk (9am–5pm weekdays) or EEI duty doctor +44 20 7123 0333 (out of hours) for urgent public health advice not related to suspected cases

Sources

Official Sources

WHO Disease Outbreak News WHO PHEIC Declaration UKHSA Ebola Clinical Guidance ACDP VHF Algorithm UKHSA Returning Workers Scheme

Suggested sources for further information:

WHO — World Health Organization
UKHSA — UK Health Security Agency
ACDP — Advisory Committee on Dangerous Pathogens
CDC — Centers for Disease Control and Prevention
ECDC — European Centre for Disease Prevention and Control
Africa CDC — Africa Centres for Disease Control and Prevention

Public Health Emergency of International Concern